Macneal Peter, Crome Christopher Robert, McNally Scarlett
King's College London, London, UK.
Department of Trauma & Orthopaedic Surgery, Queen Elizabeth University Hospital, West of Scotland, Glasgow, UK.
BMJ Case Rep. 2017 Jan 11;2017:bcr2016218240. doi: 10.1136/bcr-2016-218240.
A 43-year-old man presented with weakness of the interphalageal joint of his right thumb following the use of forearm crutches. On examination he was unable to oppose his thumb and index finger to form the 'ok' sign. Nerve conduction showed anterior interosseous nerve (AIN) damage along its path to the flexor pollicis longus. The patient was managed conservatively with little clinical improvement seen at 4 months. AIN palsies are very rare and account for <1% of all upper limb lesions. Although AIN palsies resulting from other causes such as surgery and blunt trauma are more common, we report the second case of AIN palsy following crutch use, and the first case in which clinical identification was confirmed using electrodiagnosis. Usual clinical practice recommends a prolonged period of conservative management with surgical management withheld for a minimum of 12 months. Correct crutch fitting and early identification of signs of associated injuries are of paramount importance.
一名43岁男性在使用前臂拐杖后出现右手拇指指间关节无力。检查发现他无法用拇指和示指对捏形成“OK”手势。神经传导检查显示骨间前神经（AIN）在其至拇长屈肌的走行路径上受损。患者接受了保守治疗，但4个月时临床改善甚微。AIN麻痹非常罕见，占所有上肢损伤的不到1%。虽然由手术和钝性创伤等其他原因导致的AIN麻痹更为常见，但我们报告了第二例使用拐杖后发生的AIN麻痹病例，也是首例通过电诊断确诊临床特征的病例。常规临床实践建议进行长时间的保守治疗，手术治疗至少推迟12个月。正确的拐杖适配以及早期识别相关损伤的体征至关重要。
